March 19, 2014

Kidney fixity or as it is sometimes translated Kidney stickiness, is basically cold pain
and heaviness in the lumbar region that prevents (one) from normal turning and is exacerbated
by yīn-type (dull-wet) weather, attributed to kidney vacuity cold-damp becoming
“fixed” in the inner body. 1

The typical formula used to treat this condition is Gān Cǎo Gān Jiāng Fú Líng Bái Zhú Tāng. I'd like to present a section from my upcoming translation of the Jīn Guì
Fāng Gē Kuò (金匱方歌括)- Prescriptions from the Golden Cabinet with Songs and a couple case studies illustrating its use.

A treatment for kidney
fixity
disease; where the patient experiences generalized heaviness and lumbar
coldness, as if they are sitting in water.Symptoms resemble those of water disease, yet there is no thirst,
urination is uninhibited, and eating and drinking are normal. This means that
the disease is in the lower burner.Physical taxation with sweating leads to cold and dampness in the
clothes, and over an extended period of time manifests with cold pain below the
waist, and abdominal heaviness as if carrying five thousand coins.This formula rules it.

甘草白朮（各二兩）乾薑茯苓（各四兩）

gān cǎo

甘草

6g

bái zhú

白朮

6g

gān jiāng

乾薑

12g

fú líng

茯苓

12g

上四味, 以水五升, 煮取三升, 分溫三服, 腰即溫。

Simmer the four
ingredients above in 1000ml of water until reduced to 600ml.Divide and take warm in three doses, until
the lumbus feels warm.

Song 歌曰:

腰冷溶溶坐水泉, 帶脈束於腰間, 腎著則腰帶病, 故溶溶如坐水中狀。腹中如帶五千錢, 朮甘二兩薑苓四, 寒濕同驅豈偶然?

Lumbar coldness as if sitting
in gently flowing water springs.

The girdling vessel
binds around the lumbus.

With kidney fixity there
is disease in the waist, which therefore brings the feeling as if one is
sitting in water.

The abdomen feels as if
it is carrying five thousand coins,

(With) six grams each of
bái zhú and gān cǎo, and twelve of gān
jiāng and fú ling,

is it by chance that
both cold and dampness are expelled?

Quotation by Yóu Zàijīng2 尤在涇雲:

寒濕之邪, 不在腎之中臟, 而在腎之外府, 故其治不在溫腎以散寒, 而在燠土以勝水。若用桂、附,
則反傷腎之陰矣。

Cold-damp evils are not
located in the kidney viscera but in the external dwelling of the kidneys.Therefore, treatment need not involve
warming the kidneys in order to dissipate cold, but to warm earth to prevail
over water.If guì zhī, or fù zǐ were
used, then kidney yīn would be damaged!

Case #1

A fifty-four year-old
male patient presented at the clinic with cold lumbar pain, which felt as if he
were immersed and sitting in water. In addition, he had little desire to eat or
drink, and his bowel movements were thin and loose.Tongue coating was white and his pulse was
soggy and moderate. This is a pattern of cold dampness fixed in the musculature
of the lower back. The lumbus is the house of the kidney, and (this condition) is
what is referred to in the jīn guì yào lüè as kidney fixity disease.
It is suitable here to treat by warming the center, dissipating cold,
strengthening the spleen and drying dampness with the formula gān cǎo gān jiāng
fú líng bái zhú tāng (Licorice, Ginger, Poria and Atractrylodes Macrocephala
Decoction).

gān jiāng (Zingiberis Rhizoma) 6g

gān cǎo (Glycyrrhizae Radix) 3g

fú líng (Poria) 10g

bái zhú (Atractylodis macrocephalae Rhizoma) 10g

Five packages were administered.This patient also received local treatment with moxibustion.

Afterwards his appetite had increased and his bowel movements were now
formed.

He was given another five packages of the formula above with 12g of dǎng
shēn (Codonopsis Radix) added.

After finishing the formula his back pain had completely resolved.

Taken from page 193 of the ‘Simple Commentary on the Jīn Guì Yào Lüè’ (金匮要略浅述) by Tán Rì-Qiáng (谭日强)

Case #2

A fifty-year old male
patient presented with aching pain in his lower back and legs.In addition, he experienced a fear of cold,
and heaviness of both legs after walking. His pulse was deep, moderate and
lacking strength, and his tongue was slightly enlarged with a slippery-white
coating. A yīn pulse is typically deep, and therefore this is a pattern of shào
yīn yáng qì vacuity. A moderate pulse is typically associated with dampness,
and therefore this is also a tài yīn spleen yáng weakness pattern. This pattern
is what is referred to in the jīn
guì yào lüè as kidney fixity disease. He was administered:

fú líng (Poria)
30g

bái zhú
(Atractylodis macrocephalae Rhizoma) 15g

gān jiāng
(Zingiberis Rhizoma) 14g

zhì gān cǎo (Glycyrrhizae
Radix preparata) 10g

After taking
twelve packages of the formula his legs started feeling warmer and his fear of
cold, leg heaviness after walking, and pain had completely resolved.

Taken from
page 145 from the Selected Clinical Case Studies of Liú Dù-Zhōu’ (劉渡舟臨証驗案精選)

1. (Practical
Dictionary of Chinese Medicine, Wiseman et al. pg.326)

2. Yóu Zàijīng (尤在涇) (?-1749), was a well known Qíng dynasty
scholar-physician from cháng zhōu (modern day wú county in jiāngsū province),
who had written several commentaries on hàn dynasty medical literature,
including the Jīn Guì Yì (金匮翼), Appendices to the
Golden Cabinet.